Vertebral Compression Fractures: Factors Predicting Failure of Vertebral Augmentation Kyphoplasty

To identify predictors of kyphoplasty failure in patients with vertebral compression fractures (VCFs), which may assist clinical decision-making and optimize therapeutic outcomes.

The present retrospective cohort study included patients with VCFs treated by kyphoplasty, categorized based on the presence or absence of treatment failure. Forty records were evaluated with a minimum follow-up time of 6-months, and 6 cases were excluded because they did not meet the inclusion criteria. Variables analyzed included age, sex, time to surgery, fracture level, AO Spine Injury Classification, and osteoporotic fractures (OF) score. Radiological parameters such as vertebral body height, regional and segmental kyphotic angles were measured pre- and postoperatively. Additionally, we assessed the proportion of vertebral body occupied by cement, with emphasis on its anterior and posterior distribution.

Among 34 patients, 20 (58.8%) had successful outcomes, meaning absence of failure criteria until the last follow-up (group 1), while 14 (41.2%) experienced failure (group 2). Failure was defined based on the presence of adjacent vertebral fracture, vertebral re-collapse, or recurrence of incapacitating pain. Kyphoplasty led to significant improvements in vertebral body height and kyphotic angles. In regression analysis, only the posterior cement distribution percentage emerged as an independent predictor of failure (adjusted odds ratio [OR] = 1.684; p  = 0.012). Increased posterior vertebral height gain showed a trend toward failure, whereas anterior height gain appeared protective.

A higher percentage of cement located posteriorly within the vertebral body is associated with increased kyphoplasty failure risk. These findings highlight the importance of cement distribution patterns in surgical planning for VCFs.